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Keratoacantoma Like Squamous Cell Carcinoma and Basal Cell Carcinoma, Collision Tumor in the Skin

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Keratoacantoma Like Squamous Cell Carcinoma and Basal Cell Carcinoma, Collision Tumor in the Skin Medeniyet Medical Journal 2019;34(1):104-106 Case Report / Vaka Sunumu doi:10.5222/MMJ.2019.43402 Pathology / Patoloji Keratoacantoma Like Squamous Cell Carcinoma and Basal Cell Carcinoma, Collision Tumor in the Skin Keratoakantoma Benzeri Skuamöz Hücreli Karsinom ile Bazal Hücreli Karsinomun Kollisyon Tümörü Selma Erdoğan Düzcü ID , Hesna Müzeyyen Astarcı ID , Selma Çukur ID , Ferda Aksel ID Conflict of Interest: None Cite as: Erdoğan Düzcü S, Astarcı HM, Çukur S, Aksel F. Keratoacantoma like squamous cell carci- noma and basal cell carcinoma, collision tumor in the skin. Med Med J. 2019;34(1):104-106. ABSTRACT Received: 24.04.2018 Accepted: 14.08.2018 Collision tumor refers to two or more different neoplasms within the same lesion. This tumor was consi- Publication date: 30.03.2019 dered to be coincidental, or formed as a response to epithelial and stromal changes developed in one of these tumors. Collision tumors of the skin are very rarely seen. We present herein a 48-year-old woman with a nodular lesion on the nose. The histological examination showed the presence of a collision tumor with keratoacanthoma-like squamous cell carcinoma and basal cell carcinoma developed in the same le- Selma Erdoğan Düzcü sion. The first tumor was composed of deeply infiltrated solid squamous cell islands with keratinization. Department of Pathology, At the bottom of the keratoacanthoma-like areas, there were malign tumor with keratinized squamous Abant İzzet Baysal University, cell islands with invasion to the dermis. Adjacent to this area, basal cell islands demonstrating peripheral Bolu, Turkey palisading row of cells. So, we evaluated it as a collision tumor. ✉ [email protected] ORCİD: 0000-0001-6768-1275 Keywords: Skin cancer, basal cell carcinoma, collision tumor ÖZ H.M. Astarcı 0000-0002-6553-4500 Department of Pathology, Abant İzzet Baysal University, Kollisyon tümör aynı lezyonda iki ya da daha fazla tümörün birlikte görülmesidir. Bu tümörlerin rastlantısal Bolu, Turkey ya da tümörlerden birinde gelişen epitelyal ve stromal değişikliklere yanıt olarak ortaya çıktığı düşünül- mektedir. Derinin kollisyon tümörleri nadir görülür. Bu olguda, 48 yaşında kadın hastanın burun üzerinde S. Çukur 0000-0002-6928-6284 yerleşimli nodüler lezyonu sunulmuştur. Histopatolojik incelemede aynı lezyonda gelişen keratoakantoma F. Aksel 0000-0001-7056-7908 benzeri skuamöz hücreli karsinom ve bazal hücreli karsinomun kollisyon tümörü gösterilmiştir. İlk tümör Department of Pathology, derine uzanım gösteren keratinize skuamöz hücre adalarından oluşmaktaydı. Keratoakantoma benzeri İzzet Baysal State Hospital, alanların zemininde dermise invaze atipik skuamöz hücre adaları izlendi. Bu alanlara bitişik periferal pali- Bolu, Turkey zatlama gösteren bazofilik hücre adaları izlendi. Bu nedenle kollisyon tümör olarak değerlendirildi. Anahtar kelimeler: Deri kanseri, bazal hücreli karsinom, kollisyon tümör INTRODUCTION and has the capacity to metastasize3. Squamous cell carcinoma may be seen with other tumors within the A collision tumor, which is very rare skin disease, exist same lesion. We report here a 48-year-old woman with two or more distinct neoplasms existing within with a nodule on the nose for a very long time. The the same lesion1. Collision tumors on the skin have purpose of our study was to present a collision tumor been observed to include benign and malign neop- with keratoacanthoma-like squamous cell carcinoma lasms2. Squamous cell carcinoma is locally invasive and basal cell carcinoma. © Telif hakkı İstanbul Medeniyet Üniversitesi’ne aittir. Logos Tıp Yayıncılık tarafından yayınlanmaktadır. Bu dergide yayınlanan bütün makaleler Creative Commons Atıf-GayriTicari 4.0 Uluslararası Lisansı ile lisanslanmıştır. © Copyright Istanbul Medeniyet University Faculty of Medicine. This journal published by Logos Medical Publishing. Licenced by Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0) 104 S. Erdoğan Düzcü et al. Keratoacantoma Like Squamous Cell Carcinoma and Basal Cell Carcinoma, Collision Tumor in the Skin CASE REPORT were malign tumor islands with atypical squamous cells with invasion to the dermis. Near this area and A 48-year old woman presented with a chronic the collision to the squamous cell carcinoma, there hyperkeratotic nodule on the nose. The lesion was was basal cell carcinoma. This tumor demonstrated completely excised and sent to department of patho- aggregates of basophilic staining neoplastic cells with logy. The lesion was 1 cm in size. Histology revealed well-defined contours palisading off the periphe- the presence of two adjacent tumors. These were ral row of cells. Desmoplastic stroma was also seen keratoacanthoma-like squamous cell carcinoma and (Fig. 1-2). In the same lesion, there were two tumors, basal cell carcinoma. The first tumor was composed apart from each other. So, we concluded that it was of deeply elongated and merged solid islands of lar- a collision tumor. ge, pale squamous cells with keratinization. At the bottom of the keratoacanthoma-like areas, there DISCUSSION A collision tumor on the skin refers to two adjacent tumors in the same lesion1,2. This tumor was conside- red to be coincidental, or the presence of one tumor may undergo epithelial and stromal changes which are responsible for the development of the other tu- mor1. A study by Moscarella et al.2 examined 24 collision tumors. The patients’ ages ranged from 45 to 87 ye- ars of age. The most commonly detected malignancy was basal cell carcinoma. Basal cell carcinoma and seborrheic keratosis were the most common collisi- on tumors. Squamous cell carcinoma and basal cell Figure 1. X40 HE (Hematoxylin-Eosin) Keratoacanthoma-like carcinoma were not seen together in a collision tu- squamous cell carcinoma and basal cell carcinoma (arrow: mor. keratoacanthoma-like squamous cell carcinoma, arrow head: basal cell carcinoma). Squamous cell carcinoma is a tumor which is locally invasive and has the capacity to metastasize3. Histo- pathologically, it is necessary to differentiate benign and malignant neoplasms3. Squamous cell carcinoma coexists with other malig- nant skin tumors within the same lesion. The most common combination is squamous cell carcinoma and malignant melanoma3. Keratoacanthoma is a squamous proliferative lesi- on which is characterized by frequent spontaneous resolutions3,4. Keratoacanthoma is a squamous cell proliferation with an invaginating and crateriform Figure 2. X100 HE (Hematoksilen-Eosin): Keratoacanthoma-like mass surrounding a keratin plug. There is no dermal squamous cell carcinoma and basal cell carcinoma (arrow: squ- amous cells, arrow head: basaloid cells). invasion and stromal desmoplastic reaction pattern 105 Med Med J 2019;34(1):104-106 as in the case of squamous cell carcinoma5. Some A study by Jee et al.9 presented a collision tumor with authors accepted keratoacanthoma as a low-grade basal cell carcinoma and seborrheic keratosis. squamous cell carcinoma, while others stated that it may show malignant transformation into squamous In the literature, no study presented a case of cell carcinoma5,6. keratoacanthoma-like squamous cell carcinoma and basal cell carcinoma together. So, we emphasized It is difficult to distinguish keratoacanthoma from this collision tumor and the importance of differen- squamous cell carcinoma due to their similarities4,5. tial diagnosis. Squamous cell carcinoma causes ulceration, asy- mmetry, deep dermal invasion, anaplasia and nu- REFERENCES merous of mitoses7. In differential diagnosis, clinical follow-up and pathological examination are very im- 1. Papa G, Grandi G, Pascone M. Collision tumor of malignant skin cancers: a case of melanoma in basal cell carcinoma. portant4. Moreover, squamous cell carcinoma may Pathol Res Pract. 2006;202:691-4. be a tumor which metastasizes, while keratoacant- https://doi.org/10.1016/j.prp.2006.01.016 4 2. Moscarella E, Rabinovitz H, Oliviero MC, et al. The role of homa does not metastasize . reflectance confocal microscopy as an aid in the diagnosis of collision tumors. Dermatology. 2013;227:109-17. https://doi.org/10.1159/000351771 Keratoacanthoma-like squamous cell carcinoma is 3. Tan KB, Tan SH, Aw DJW, et al. Simulators of squamous cell a borderline tumor between keratoacanthoma and carcinoma of the skin: diagnostic challenges on small biopsi- squamous cell carcinoma7. It is a lesion which histo- es and clinicopathological correlation. J Skin Cancer, 2013. https://doi.org/10.1155/2013/752864 pathologically resembles keratoacanthoma, but its 4. Watanabe IC, Magalhães RF, de Moraes AM, et al. Keratoa- cellular morphology is too atypical7. canthoma and keratoacanthoma-like squamous cell carcino- ma: similar morphology but different pathogenesis. Medici- ne. 2013;94(23):e934. A study by Arnault et al.5 examined 13 skin lesions https://doi.org/10.1097/MD.0000000000000934 associated with sorafenib therapy. Five of these were 5. Arnault JP, Wechsler J, Escudier B, et al. Keratoacanthomas and squamous cell carcinomas in patients receiving sorafe- diagnosed as keratoacanthoma-like squamous cell nib. J Clin Oncol. 2009;27(23):e59-e61. carcinoma. These tumors were characterized with https://doi.org/10.1200/JCO.2009.23.4823 6. Misago N, Takai T, Murata Y, Nagase K,Narisawa Y. Ca- a crateriform pattern by pushing borders and disor- ses with a spontaneous regression of an infiltrating derly nests which invaded the dermis5. non-crateriform keratoacanthoma and squamous cell carci- noma with a keratoacanthoma-like component. J Dermatol.
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